A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Thursday, January 08, 2009

Limits Gone Wild

I saw a little girl the other day with a splinter in her knee.

Her parents had done their best to get it out, but didn't think they had gotten all of it. When I took a look, I saw what looked like a tiny splinter remnant about 3 millimeters long (ie, really small) nestled in the bottom of a small cut. I pressed on it gently and asked the kid if it hurt. From experience both clinical and personal, I've found that this is a fairly decent way to tell if there's anything still in there. She didn't complain much, so I wasn't all that worried.

I got my splinter forceps, pushed upward on the visible part of what might have been the rest of the splinter and managed to grasp it. Then I pulled...

And kept on pulling, until lo and behold a full half inch (11 mm; I measured) of splinter materialized before my eyes. It was impressive, given that it must have gone straight "down" into her knee, as opposed to tangentially along the skin, which is what the original wound looked like. The kid did great; nary a wince and not a peep. I put the splinter into a little tube and gave it to her to take home to show Daddy, along with stickers (my office goodies-of-choice.)

What does this have to do with limits? In the course of the visit, the mom mentioned to me that school nurses are no longer allowed to take out splinters when kids acquire them at school. That struck the both of us as pretty stupid. Why make a kid suffer with a splinter all day instead of at least trying to give it a little tug. It doesn't really apply to this case, but it struck me as just the latest in the slow and lingering death of common sense as it succumbs to the continued onslaught of the lawyers. The new prohibition is clearly the result of increasing liability fears.

I've posted several times bemoaning the failure of assorted medical personnel to recognize their limits. As it happens, I do feel that there are some groups of people who are better at this vital life skill than others. Among them tend to be school nurses (and often, parents.) This family only brought the kid to me after giving it their all to get this nasty splinter out on their own. I'm pretty confident that a school nurse would be even quicker to punt. But forbidding them to even touch it in the first place? The nanny state strikes once again, when fears of lawsuits outweigh a child's comfort.

Our "school nurse" let my neighbors kid stay at school for the remainder of the day (55 mins) with a badly broken thumb. Her thinking was, she's going home soon why call mom. She went home, on a bus, that took 45 mins to arrive. Mom was a bit angry. But of course nothing happened to the nurse after that...

How sad is it that a school nurse has to worry about litigation rather than removing a splinter or giving a Tylenol. (In our town they are not allowed to do anything even WITH parental permission). So stupid.

As a critical care paramedic, I can perform surgical cricothyrotomies. I am trained to insert chest tubes, various central lines and perform EKG-guided pericardiocentesis, should the situation demand it.

At 43 it's fairly safe to say I survived school nurses and my parents nursing. On more than one occasion (I was a madhouse tomboy) I would of been in dire straits and the favorite among the hospital staff for all the times the school nurse came to my rescue.

I think these days we are on the threshold of babying too much. Kids are being force fed easy in the stead of playful and energetic. I miss those days of old, scraped knees and scars be damned.

Having said all that, my biggest splinter was an inch and a half. It was also glass embedded in the sole of my foot. As a child I had tripped over a Coke bottle and stepped in the glass. I wasn't even aware of the glass shard until I became pregnant with my daughter. My foot had swollen up and pushed the shard into a delicate part of my sole. That was 13 year old sliver. Kids are alot more resilent than people give them credit for. (Hugs)Indigo

I am a school nurse in the beautiful Garden State and we do take out splinters. I have had parents have kids wait to see me to get them out,if I can't or they look infected then I send them to their MD's office. Love the Dinosaur Blog!!

Oh, I just loved our school nurses. Back in grade school, I got shoved off my feet and hit my head on a raised concrete "steam tunnel" access hatch, and passed out on the stairs trying to get some help. School nurse never called my parents. Hello? Even mild concussions need to be seen to.

And there was no call to my parents when I got deliberately kicked in the face and could've used stitches in the gash caused by soft tissue being compressed between shoe and teeth. (Oh, and just to add insult to injury, the teacher "monitoring" the playground did not see the event, yet called me a liar when I told her I'd been kicked; her explanation was that it was "an accident". Yeah, right. The kid ran over to the edge of the ledge, stopped, hauled back his foot, and kicked hard. Some "accident"...)

You could be in the same condition our school district is in - there is a rotation of parent volunteers run by the PTA part time in lieu of any school nurse and all they're allowed to do is fill out a form or call parents. Not even bandaids - they can hand it to the kid but the kid has to put it on themselves.

I hate splinters...90% of the time there's nothin there and you spend 30 minutes breakin Hippocrates first rule...had a similar case last year with an 80-something man, he was sure he had something in his thumb but all the ER gave him was an RX for Keflex and a Tetanus, his FP threw up his hands like an NFL ref, and it didn't look impressive, but pulled out the last inch (I don't do metric) of one of those pointy toothpicks they still have at the cashier in Southern Waffle Houses....

Weeell, my kids' school didn't have nurses. It did have a some very splintery playground toys. It also had a couple of officious secretaries who were forever trying to remove the kid's splinters (without parental permission, I might add) and botching the job leaving me a BIGGER mess to clean up when they came home. I finally told them to leave the kids alone, and it they didn't think it could wait till after school to call me at the office. This was in the early 1990's, so not all that long ago.

Our elementary school still has a nurse, if you count the woman who comes in once a month to do hearing screens and not much else. All the things the school nurse used to do when I was a kid are relegated to our awesome secretaries, who don't even blink when the whole third grade comes in for a lice check. They watch while one 6th grader self-administers his injectable insulin, and they pass out band-aids and "ice packs" that are two layers of frozen paper towel in a baggie. Gone are the days of the evil mercurochrome -- the secretaries aren't even allowed to apply soap to an obviously filthy playground scrape. They can't even help the student wash it out. I'm at the school most days, and so when my kids come in with bleeding or splinters, I use the nurse's office and put on my Dr. Mom hat. But if I need antibiotic ointment, I have to go raid the principal's personal stash.

My grade school had a school nurse (allegedly, anyways - I was lucky enough never to actually need to see her, asides from hearing screens, dental exams, and in-school vaccinations), but from middle school onward, if my school had one at all, she was only there about half the day. My high school had a nurse who was there half the day...twice a week. The rest of the time, she was scheduled at a school on the other side of town; I dunno, maybe the school board figured the kids over there were more prone to injuring themselves or something - the fact that the other school actually had a workshop class, where mine was more art-and-music-oriented might've had something to do with that.